Patterns of care for women with ovarian cancer in the United States.

PURPOSE: To characterize treatments for ovarian cancer, to determine if recommended staging and treatment were provided, and to determine factors that influence receipt of recommended staging and treatment. METHODS: A total of 785 women diagnosed with ovarian cancer in 1991 were selected from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program. Type and receipt of recommended staging and treatment were examined using data on surgery and physician-verified chemotherapy. RESULTS: Most women with presumptive stage I and II ovarian cancer were treated with surgery alone (58%), while women with stage III or IV disease were treated with surgery plus platinum-based chemotherapy (75% stage III, 56% stage IV). Approximately 10% of women with presumptive stage I and II, 71% with stage III, and 53% with stage IV disease received recommended staging and treatment. The absence of lymphadenectomy and assignment of histologic grade were the primary reasons women with presumptive stage I and II cancer did not receive recommended staging and treatment, whereas for stages III and IV, it was due to older women not receiving surgery plus platinum-based adjuvant chemotherapy. Age, stage, comorbidity, "other" race/ethnicity, and treatment at a facility with an approved residency training program were associated with whether recommended staging and therapy were received. CONCLUSION: Older women with late-stage disease did not receive recommended treatment. The majority of women with early-stage disease did not receive recommended staging and treatment.

Food intakes of US children and adolescents compared with recommendations.

OBJECTIVES: To determine the proportion of youth meeting national recommendations for food group intake and to identify food intake patterns. DESIGN: The US Department of Agriculture's 1989-1991 Continuing Surveys of Food Intakes by Individuals were used to estimate food intake. Intake was determined from 3 days of diet by disaggregating foods into their component ingredients and using weights that correspond to servings. PARTICIPANTS: The sample included 3307 youth, 2 to 19 years of age, living in the 48 conterminous United States. Main Outcome Measures. Mean number of servings and percentage of individuals meeting national recommendations for food group intake according to demographic characteristics, patterns of intake, and nutrient profiles associated with each pattern. RESULTS: Mean numbers of servings per day were below minimum recommendations for all food groups except the dairy group (ages 2 to 11). Percentages of youth meeting recommendations ranged from approximately 30% for fruit, grain, meat, and dairy to 36% for vegetables. Sixteen percent of youth did not meet any recommendations, and 1% met all recommendations. The pattern of meeting all recommendations resulted in nutrient intakes above the recommended dietary allowances and was high in fat. Conversely, meeting none of the recommendations resulted in intakes well below the recommended dietary allowances for some nutrients. Total fat and added sugars averaged 35% and 15% of energy, respectively, and levels were similar among most demographic groups. CONCLUSION: Children and teens in the United States follow eating patterns that do not meet national recommendations. Nutrition education and intervention are needed among US children.

Insulin attenuates atrophy of unweighted soleus muscle by amplified inhibition of protein degradation.

Unweighting atrophy of immature soleus muscle occurs rapidly over the first several days, followed by slower atrophy coinciding with increased sensitivity to insulin of in vitro protein metabolism. This study determined whether this increased sensitivity might account for the diminution of atrophy after 3 days of tall-cast hindlimb suspension. The physiological significance of the increased response to insulin in unweighted muscle was evaluated by analyzing in vivo protein metabolism for day 3 (48 to 72 hours) and day 4 (72 to 96 hours) of unweighting in diabetic animals either injected with insulin or not treated. Soleus from nontreated diabetic animals showed a similar loss of protein during day 3 (-16.2%) and day 4 (-14.5%) of unweighting, whereas muscle from insulin-treated animals showed rapid atrophy (-14.5%) during day 3 only, declining to just -3.1% the next day. Since fractional protein synthesis was similar for both day 3 (8.6%/d) and day 4 (7.0%/d) of unweighting in insulin-treated animals, the reduction in protein loss must be accounted for by a slowing of protein degradation due to circulating insulin. Intramuscular (IM) injection of insulin (600 nmol/L) stimulated in situ protein synthesis similarly in 4-day unweighted (+56%) and weight-bearing (+90%) soleus, even though unweighted muscle showed a greater in situ response of 2-deoxy-[3H]glucose uptake to IM injection of either insulin (133 nmol/L) or insulin-like growth factor-I (IGF-I) (200 nmol/L) than control muscle. These findings suggest that unweighted muscle is selectively more responsive in vivo to insulin, and that the slower atrophy after 3 days of unweighting was due to an increased effect of insulin on inhibiting protein degradation.

Recall of body weight and body size estimation in women enrolled in the breast cancer detection and demonstration project (BCDDP).

OBJECTIVE: To examine the relationship between body mass index (BMI) and pictorial representations of body size in women from young adulthood to late mid-life. DESIGN: Retrospective, descriptive study of BMI and pictorial estimation of body size. SUBJECTS: 5,807 women age 33-77 years enrolled in the National Cancer Institute's and American Cancer Society Breast Cancer Detection and Demonstration Project (BCDDP). MEASUREMENTS: Body weight and height were measured in 1973. In 1977, a subset of the cohort recalled their usual height and weight at 10 y intervals starting at age 20. In 1987, subjects reported their usual and current weight and selected one of nine pictorials best representing their body size at ages 15, 25, 40, 50 and +60 y. RESULTS: For the cohort, and among White women, Pearson correlations between recalled BMI (Kg/M2) and pictorials for each decade ranged from 0.62-0.67 and was 0.80 for current BMI and current pictorial. The range of correlations between pictorials and recalled BMI for other race/ethnic groups were 0.72-0.87 (Black), 0.53-0.75 (Hispanic) and 0.28-0.87 (Asian). Among a subset of women with data on measured BMI, recalled BMI and pictorials at specific ages, the correlation between pictorials and measured BMI was 0.75, compared to the correlation between recalled BMI and measured BMI which was 0.89. CONCLUSION: Correlations are higher between recalled BMI and measured BMI compared to the correlation between pictorials and measured BMI. Therefore, estimates of body size by pictorials alone may not be appropriate for epidemiological investigations. Alternate uses of pictorials may include assessment body weight in low literate populations or in instances where body weight is not or has not been measured.

Skeletal muscle protein content and synthesis after voluntary running and subsequent unweighting.

The effects of exercise training with or without subsequent unweighting on wet weight, protein content, and in vivo fractional protein synthesis were studied in soleus and plantaris muscles of juvenile female Sprague-Dawley rats under the following four conditions: normal weight bearing (N), voluntary-activity wheel running (WR) for up to 4 weeks, mechanical unweighting for 7 days via hindlimb suspension (HS), or wheel running followed by 7 days of hindlimb suspension (WR-HS). Fractional protein synthesis was determined by the 3H-phenylalanine flooding method. Increases (P < .05) in wet weight and protein content were detected in the soleus after just 1 week of running, with no increase in fractional protein synthesis. Two weeks of running were required for an increase in protein synthesis in this muscle. Significant increases in these parameters were first observed in the plantaris after 2 weeks of running. Maximal increases occurred by 3 weeks in both muscles. Reductions (P < .05) in soleus and plantaris parameters were observed in both HS and WR-HS groups compared with N and WR groups, respectively. However, protein content and fractional synthesis were maintained at significantly higher levels in WR-HS muscles compared with HS muscles. These results indicate that (1) wheel training represents a noninvasive method for inducing rapid hypertrophy of the skeletal muscles studied, in part by increasing fractional protein synthesis; (2) unweighting decreases protein content and synthesis to the same extent whether the muscles are trained; and (3) previously hypertrophied muscles display higher protein contents and fractional protein synthesis following unweighting compared with unweighted muscles of untrained animals.

Cardiac protein content and synthesis in vivo after voluntary running or head-down suspension.

The adaptive responses of myocardial protein metabolism to chronic increases in work load were evaluated in juvenile female Sprague-Dawley rats. Rats were studied under four conditions: normal weight bearing (N), voluntary wheel running (WR) for < or = 4 wk, head-down-tilt suspension for 7 days (HS), or wheel running (2 or 3 wk) followed by 7 days of suspension (WR-HS). WR activity plateaued after 2 wk at 16 km/day and was maintained through week 4. WR did not affect normal whole body growth. Protein metabolism was studied by measuring heart protein content and in vivo fractional rate of protein synthesis with the [3H]phenylalanine "flooding dose" method. Two weeks of WR increased (P < 0.05) absolute heart protein content (22%) and protein synthesis (21%) relative to age-matched N group values. These differences in protein content and synthesis were maintained for > or = 4 wk. Rats failed to gain significant body weight during suspension. Heart protein content increased (P < 0.05) by 12% to 26% as did protein synthesis (14% to 22%) in HS compared with N group. In WR-HS group, cardiac protein content and protein synthesis were maintained at significantly elevated levels. These findings indicate that 1) high-volume WR by young rats provides a convenient noninvasive method for producing rapid and substantial cardiac hypertrophy, which results, at least in part, from enhanced cardiac protein synthesis; and 2) head-down suspension of sedentary juvenile rats leads to increased cardiac protein synthesis, which helps to increase cardiac protein content despite a lack of whole body growth.

Elevated interstitial fluid volume in soleus muscles unweighted by spaceflight or suspension.

Recent evidence by Kandarian et al. (J. Appl. Physiol. 71: 910-914, 1991) indicates that prolonged (28 days) unweighting of the rat soleus by hindlimb suspension results in a substantial increase in interstitial fluid volume (IFV), as defined by the inulin space. The lack of any significant difference in absolute IFV values between unweighted and control groups suggested that this elevated IFV was a consequence of muscle atrophy. Using young female rats, we directly tested this hypothesis by comparing the early responses of soleus muscle weight and IFV with unweighting by tail-cast suspension or actual exposure to microgravity during spaceflight. Significant differences from control were first observed after 3 days of suspension unweighting for soleus wet weight (-14%; P < 0.01) and IFV (+35%; P < 0.01) and increased further after 6 days (-32% and +53%, respectively; both P < 0.001). After 5.4 days of spaceflight, soleus wet weight was 38% less and IFV was 52% greater than control (both P < 0.001). A highly significant negative correlation between soleus wet weight and IFV for all groups was observed (r = -0.70, P < 0.001). These data indicate that elevated soleus IFV develops at an early time point during unweighting and that there is a direct relationship between the magnitude of this increase in IFV and the extent of muscle atrophy. This relationship also exists in soleus muscles unweighted by exposure to a microgravity environment.

Time course of the response of myofibrillar and sarcoplasmic protein metabolism to unweighting of the soleus muscle.

Contributions of altered in vivo protein synthesis and degradation to unweighting atrophy of the soleus muscle in tail-suspended young female rats were analyzed daily for up to 6 days. Specific changes in myofibrillar and sarcoplasmic proteins were also evaluated to assess their contributions to the loss of total protein. Synthesis of myofibrillar and sarcoplasmic proteins was estimated by intramuscular (IM) injection and total protein by intraperitoneal (IP) injection of flooding doses of 3H-phenylalanine. Total protein loss was greatest during the first 3 days following suspension and was a consequence of the loss of myofibrillar rather than sarcoplasmic proteins. However, synthesis of total myofibrillar and sarcoplasmic proteins diminished in parallel beginning in the first 24 hours. Therefore sarcoplasmic proteins must be spared due to a decrease in their degradation. In contrast, myofibrillar protein degradation increased, thus explaining the elevated degradation of the total pool. Following 72 hours of suspension, protein synthesis remained low, but the rate of myofibrillar protein loss diminished, suggesting a slowing of degradation. These various results show (1) acute loss of protein during unweighting atrophy is a consequence of decreased synthesis and increased degradation of myofibrillar proteins, and (2) sarcoplasmic proteins are spared due to slower degradation, likely explaining the sparing of plasma membrane receptors. Based on other published data, we propose that the slowing of atrophy after the initial response may be attributed to an increased effect of insulin.

Spaceflight on STS-48 and earth-based unweighting produce similar effects on skeletal muscle of young rats.

Our knowledge of the effects of unweighting on skeletal muscle of juvenile rapidly growing rats has been obtained entirely by using hindlimb-suspension models. No spaceflight data on juvenile animals are available to validate these models of simulated weightlessness. Therefore, eight 26-day-old female Sprague-Dawley albino rats were exposed to 5.4 days of weightlessness aboard the space shuttle Discovery (mission STS-48, September 1991). An asynchronous ground control experiment mimicked the flight cage condition, ambient shuttle temperatures, and mission duration for a second group of rats. A third group of animals underwent hindlimb suspension for 5.4 days at ambient temperatures. Although all groups consumed food at a similar rate, flight animals gained a greater percentage of body mass per day (P < 0.05). Mass and protein data showed weight-bearing hindlimb muscles were most affected, with atrophy of the soleus and reduced growth of the plantaris and gastrocnemius in both the flight and suspended animals. In contrast, the non-weight-bearing extensor digitorum longus and tibialis anterior muscles grew normally. Earlier suspension studies showed that the soleus develops an increased sensitivity to insulin during unweighting atrophy, particularly for the uptake of 2-[1,2-3H]deoxyglucose. Therefore, this characteristic was studied in isolated muscles within 2 h after cessation of spaceflight or suspension. Insulin increased uptake 2.5- and 2.7-fold in soleus of flight and suspended animals, respectively, whereas it increased only 1.6-fold in control animals. In contrast, the effect of insulin was similar among the three groups for the extensor digitorum longus, which provides a control for potential systemic differences in the animals.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of a space food bar diet on body and muscle mass in normal and hind-limb suspended rats.

A food bar diet is used for rats in space flight. Since ground based studies have only been performed with the typical rat chow in dry pellet form, we tested whether the food bar diet allows normal growth and normal response of muscle protein content to unloading. These parameters were measured in normal and tail-cast hind limb suspended rats fed standard pellets or food bars. Body mass following 5 d of hind limb unloading was similar in bar-fed (97.9 +/- 4.8 g) and pellet-fed (92.6 +/- 3.4 g) animals (p greater than 0.05). In addition, gains in body mass were comparable between bar-fed (5.3 g/d) and pellet-fed (5.1 g/d) animals. Food bar consumption over 6 d increased from 10.5 to 12.0 g/d animal. During 5 d of hind limb suspension, food bar consumption increased from 13.2 +/- 1.4 to 19.1 +/- 1.4 g/d per animal. In agreement with previous studies, hind limb unloading reduced soleus muscle mass and protein content per 100 g body mass in both diet groups (p less than 0.05). Protein content per 100 g body mass was unchanged for the plantaris, extensor digitorum longus and tibialis anterior muscles during suspension in both diet groups. Rodent consumption of a food bar diet results in normal gains in body mass and muscle protein when compared to a standard pellet diet, and does not alter the atrophic response of skeletal muscle to unloading.